title: Abdominopelvic tuberculosis mimicking advanced ovarian cancer and pelvic inflammatory disease: a series of 28 female cases.
abstract: OBJECTIVE
  To present and discuss 28 female cases with abdominopelvic tuberculosis (TB) and abnormal CA125 levels to better distinguish this disease from advanced ovarian cancer (AOC) and pelvic inflammatory disease (PID). Abdominopelvic tuberculosis (APTB) is one of the extrapulmonary tuberculosis (TB) sites, usually misdiagnosed as AOC and PID and then has to undergo surgery. However, the treatment of APTB is totally based on medical therapy other than surgery except biopsy. This article aims to present and discuss 28 female APTB cases with abnormal CA125 levels to better distinguish this disease from AOC and PID so as to find out non-invasive APTB diagnosis methods.
  
  
  METHODS
  28 APTB patients diagnosed between January 2000 and January 2010 in our gynecologic department of Nanjing Jinling hospital were reviewed retrospectively and compared with AOC and PID.
  
  
  RESULTS
  The mean age was 38.24 ± 11 (range 15-64) years. Elevated levels of serum CA125 were determined in all 28 patients (100%). Other common findings were ascites in 20 (71.43%, 20/28), pelvic mass in 21(75%, 21/28), slight fever with night sweat in 13 (46.43%, 13/28), cough and pleural effusion in nine (32.14 %, 9/28), high fever more than 39 °C combined with abdominal pain and elevated white blood count in five (17.86%, 5/28), weight loss more than 5 kg at admission in six (21.43%, 6/28). Diagnoses were made based on biopsy from laparotomy in 14 (50%) patients, from laparoscopy in nine (32.14%), from diagnostic curettage because of primary infertility in two (7.14%), and only from clinical suspicion in three patients. Histopathology revealed that caseating granulomatous lesions were seen in 25 patients, positive anti-acid staining in 11 patients. Totally 26 patients completed anti-TB therapy successfully and were cured, two patients died of the disease because of long-term immune inhibitor used.
  
  
  CONCLUSIONS
  Although it is difficult to exactly distinguish APTB from AOC and PID without operation, it is important because the treatment of APTB is totally based on medical therapy other than surgery. Some difference may be found out if clinical manifestation, physical examination, laboratory tests and imaging findings are carefully analyzed to avoid unnecessary extensive surgery and improve the prognosis.
authors.affiliation: Department of Gynecology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Liu
authors.forename: Qin
authors.initials: Q
authors.lastname: Zhang
authors.forename: Qun
authors.initials: Q
authors.lastname: Guan
authors.forename: Jin-feng
authors.initials: JF
authors.lastname: Xu
authors.forename: Qun-li
authors.initials: QL
authors.lastname: Shi
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001706:Biopsy; D018394:CA-125 Antigen / Q000097:blood*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000175:diagnosis; D000292:Pelvic Inflammatory Disease / Q000175:diagnosis; D014395:Peritonitis, Tuberculous / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D010808:Physical Examination; D012189:Retrospective Studies; D014385:Tuberculosis, Gastrointestinal / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality
chemical_list: D000995:Antitubercular Agents; D018394:CA-125 Antigen